Doctor Answers 10

Bottoming out and double bubble after breast implants - solutions

October 12th, 2012

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Bottoming out happens when your breast tissues can't hold the weight of the breast implants. The implants descend as the skin and breast tissue stretch. The "double bubble" happens when the implant slides below the old breast crease and the old crease leaves an indentation across the breast. One way to approach bottoming out and a double bubble is to raise the position of the implant by reattaching the skin to the chest to reestablish the old breast crease. This is done with internal stitches. This can work, but the problem is that the tissues may stretch again. One way to strengthen the repair is to add an internal sling to help support the implant. Biological meshes like Strattice can work well for this. Unfortunately, Strattice is very expensive. The added cost may save you money, however, by reducing revision risk in the future.

HELLO

October 12th, 2012

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Thank you for your pictures, it looks like you have a double bubble that with time it can be improved. In our practice we have our patients wear a breast band to help the fold. It’s your old fold you are seeing and the skin needs to stretch out.

I think you may benefit from revisionary breast surgery; as you can imagine, precise advice will necessitate direct examination. Most likely, you will benefit from “reconstruction” of the inframammary fold areas using internal suture techniques (capsulorraphy). These internal sutures will help prevent the breast implants from displacing and should correct the appearance of the "double bubble" ( created by the prominence of breast tissue sitting over the lower breast implant).

Seek consultation with well experienced board-certified plastic surgeons; ask to see lots of examples of their work helping patients in your situation.

Bottoming out or double bubble

October 20th, 2012

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You have many options including doing nothing at all. I see adouble bubble on the left side and bottoming out on both. The implants may need to be repositioned with a alloderm or other form of sling for reinforcement.

Fold malposition correctio

October 13th, 2012

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Agree with your assessment. Sometimes these malposition terms get confusing- double bobble, bottoming out, fold malposition etc. in essence your fold became disrupted and the implant fell. Correction involves correcting the fold - sometimes using a tissue support like Strattice. Start with your original surgeon for a consultation and seek other advice if they are not helpful.

Bottoming Out/double Bubble? What Would You Do? (photo)

October 13th, 2012

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Notwithstanding my esteemed colleagues recommendation, and your desire for improvement, there are multiple complex reasons for your "double bubble." Still, it is only visible from certain angles and most visible with your arms elevated, and it is not as prominent as others I've seen. The problem results from your pre surgical breast anatomy, chest wall dimensions, and FDA imposed limitations on sizes and shapes of implants available to American women. My first choice to correct this problem would be extremely careful fat grafting along the lower edge of implant to camouflage it.

Bottoming out

October 13th, 2012

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From your photos it looks like your implant has descended below the desired position and you do have bottoming out on this side. I do not think external support will solve your problem and that you will need revisional surgery to elevate the fold with internal capsulorraphy sutures.

Bottoming Out/double Bubble?

Other than the option you have excluded, which is no treatment, the other choice is surgery to reef up the breast fold.

There are two groups of operations to do this. One uses your own tissue, one uses a product:---

Using your own tissues, sutures are placed to create the breast fold-(inframammary fold). The upside is there is no foreign tissue. The downside is that your own tissue has already failed.

Using acellular dermal matrix, usually a product known as Strattice. This is a biologic product used to support the implant and the fold, which is gradually replaced by your own tissue that grows into the matrix. Upside is high success rate. Downside is expense of the product and cost of extra operating time to insert it.

Discuss all possibilities with your surgeon. Thanks for your question and for the excellent photos. Best wishes.

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